2. One minute, and again at five
minutes after birth, the infant is
assessed using the APGAR
scale.
Within seconds after birth of the healthy
newborn, the umbilical cord is clamped and
cut, mucous is suctioned from the nose and
throat, and a cap is placed on the head to
help prevent heat loss and stabilize body
temperature. Some doctors commonly
prescribe an injection of Vitamin K. This
would prevent any incidence of
hemorrhagic disease ( heavy bleeding).
Antiseptic ointment may
be put in the eyes to
prevent infections of the
cornea that might result
during vaginal delivery.
This replaces the diluted
silver nitrate formerly
used.
3. Score 0 Score 1 Score 2
Heart rate absent <100 >100
Respiration absent weak or irregular strong
Muscle tone none some flexion active movement
Reflex irritability
no response
to stimulation
grimace/feeble cry
when stimulated
sneeze/cough/pulls away
when stimulated
Skin color blue all over blue at extremities normal
The Apgar score was devised in 1952 by Virginia
Apgar as a simple and repeatable method to
quickly and summarily assess the health of
newborn children immediately after childbirth.
The Apgar score is determined by evaluating the
newborn baby on five simple criteria on a scale
from zero to two and summing up the five values
thus obtained. The resulting Apgar score ranges
from zero to 10.
4. The purpose of the Apgar test is to
determine quickly whether a newborn
needs immediate medical care; it was
not designed to make long-term
predictions on a child's health.
Some ten years after the initial
publication, the acronym APGAR was
coined in the US as a “mnemonic”
learning aid:
The APGAR test is generally done at
one and five minutes after birth, and
may be repeated later if the score is,
and remains, low. Scores of 0-2 are
generally regarded as critically low
or “poor”, with 3 to 7 indicating
“fair” condition and 8-10 generally
normal or “good”. The one minute
scores usually indicate how well the
baby tolerated the delivery. The 5
minute scores indicate their
adaptation to the new environment.
A score of “0” at both 1 and 5
minute intervals might generally
indicate a stillborn baby.
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration.
5. Heart rate - range 120 to 160 beats per minute
Common variations:
Heart rate range to 100 when sleeping to 180 when crying
Heart rate may be irregular with crying
Respiration - range 30
to 60 breaths per
minute
Common variations
Bilateral bronchial breath
sounds
Moist breath sounds may be
present shortly after birth
Babies in distress may be placed in an incubator for
relief and constant monitoring of vital signs.
6. We would expect to see well-flexed,
full range of motion, spontaneous
movement
Signs of potential distress or deviations from expected findings
Posture limp Asymmetry of movement
Persistent tremor, twitching
7. Reflex irritability is scored on the basis of the infant’s
response to stimuli, such as a mild pinch.
No response to a pinch= a
score of 0 points.
A grimace or feeble cry = a
score of 1 point.
A lusty cry scores 2
points on the APGAR!
To “pinch” baby and encourage crying is in conflict with the Leboyer method of
childbirth. This method is used to minimize trauma to the infant during and after
delivery. The room is dimly lit and quiet, the baby’s head is not pulled. The
infant is massaged or given a warm water bath. This is all in direct contrast to
the outdated method of smacking baby’s bottom to encourage deep breaths!
8. Expected findings:
Skin reddish in color, smooth and puffy at birth
At 24 - 36 hours of age, skin is flaky, dry and
pink in color; it is excessively flaky in babies that were overdue
Edema (excess fluid causes swelling) around eyes, feet, and genitals
Some vernix caseosa or lanugo may remain
Common variations:
Acrocyanosis – blue colored fingers, toes, hands,
and/or feet are the result of sluggish
peripheral circulation
Mongolian spots – Patches of purple-black or
blue- black color distributed over backside of
infants of African-American or Asian descent.
Resolves in time.
Mottling -
Generalized red
and white
discoloration of
skin of chilled
infants with fair
complexion
9. Jaundice is a yellow discoloring of the skin,
mucous membranes, and eyes, caused by too
much bilirubin (a breakdown product of
hemoglobin made by the liver) in the blood. High
levels of bilirubin circulating in the blood stream
dissolve in the subcutaneous fat (the layer of fat
just beneath the skin), causing a yellowish
appearance of the skin and the whites of the eyes.
Using bili lights is a therapeutic procedure
performed on newborns to reduce elevated
levels of bilirubin, which tends to accumulate in
the brain tissue, and can cause permanent brain
damage.
The bili lights, like sunlight, allow the body to
manufacture Vitamin D. This vitamin is
manufactured by the body when the skin is
exposed to sunlight, and affects liver function. In
very mild cases of jaundice, baby might simply
be placed in the window on a sunny day.
In newborns, jaundice
often exists due to an
immature liver.
10. Head circumference - 33 to 35 cm
Expected findings:
Head should be 2 to 3 cms larger than chest
Chest circumference - 30.5 to 33 cm
Common variations:
Molding of head may result in a lower head circumference measurement: Fontanelles should be
soft, firm, and flat. Bulging fontanelles may indicate distress or deviation from normal
Head and chest circumference may be equal for the first 24 to 48 hours of life.
On average, the newborn
infant weighs 7 pounds and is
20 inches long.
Weight range - 2500 - 4000 gms (5 lbs.
8oz. - 8 lbs. 13 oz.)
Length range - 48 to 53 cms (19 - 21
inches)
Once the APGAR scores and general measurements are determined,
additional reflexes will be tested. In fact, they will continue to be tested
throughout the first year of life in order to evaluate neurological function and
development. Absent or abnormal reflexes in an infant, persistence of a reflex
past the age where the reflex is normally lost, or redevelopment of an infantile
reflex in an older child or adult may suggest problems with the nerve system.
11. The Moro response is a normal reflex for an infant when he or she is startled,
feels like they are falling, or their head drops back. A loud noise should also
elicit this reflex. The infant will have a "startled" look and the arms will fling
out sideways with the palms up and the thumbs flexed OR are quickly drawn
upward. Absence of the Moro reflex in newborn infants is abnormal and may
indicate an injury or disease.
Remember the correct definition of reflex: an automatic and involuntary
reaction as the result of the nervous systems’ response to a stimulus.
12. When your baby's head
is turned to one side, the
arm on that side
stretches out and the
opposite arm bends up
at the elbow. This is
often called "fencing."
Baby's may sleep in this
position for years, but
when awake, this reflex
usually disappears by
the age of 4 months.
14. The stepping or walking reflex is present at birth. If the infant is held erect
and the feet come in contact with a surface, the infant will make step-like
movements. Some parents incorrectly interpret this movement as a desire to
stand and walk. It is important that this motion is not allowed to be weight-
bearing, as leg muscles are not developed. It is interesting that this reflex
occurs even if the baby is held upside down and the feet come in contact
with a surface.
15. When your baby is placed on his/her stomach, they will automatically
assume a "crawling" position. This usually disappears by 4 months.
When the position reappears, it is closer to 6 – 10 months. At that point
the baby will actually be learning to crawl rather than just exhibiting a
reflex movement.
16. A mild pinch or slapping on the
bottom of the foot elicits the
flexion reflex. This causes the
body to automatically draw back
from the painful stimulus. It is a
reflex for protection or survival.
17. The sucking reflex
may have been
present long
before birth, as
shown above in
this fetus.
This reflex will
allow the infant to
ingest food from
the nipple of a
bottle or breast.
As shown in the
picture above, this
reflex occurs when
any nipple-sized
object is placed on
the baby’s lips.
18. Rooting reflex When you stroke the corner of your baby's mouth
and move your finger slowly toward his ear you will see his tongue,
mouth, and sometimes even his head follow the direction of your
hand. They also open their mouth. This reflex helps babies to locate
the nipple for feeding. This usually disappears by 3-4 months.
1. 2.
19. When you stroke the bottom of your baby's foot, the big toe flexes
toward the top of the foot, the other toes fan out, and the leg extends
outward. This usually disappears by 9 months to 2 years, when the
toes curl under and the leg is pulled back.
Also known as the Extensor Plantar
Reflex or Toe Sign
20. The infants’ eyes will
open and close in
response to a touch on
the face, a bright light, a
loud sound, a strong
odor, or a bitter taste.
This reflex serves to help
protect the eyes, and is
present during the entire
lifetime.
21. The infants’
pupils open
automatically
in response to
weak light
and contract
in response to
bright light.
This reflex not
only allows
for better
vision, but
protects the
eyes. It is
present
throughout
the lifetime.
22. A stork bite is a vascular lesion quite common in newborns consisting of one
or more pale red patches of skin. Most often stork bites appear on the
forehead, eyelids, tip of the nose, upper lip or back of the neck. They are
usually gone within 18 months of birth. Some may be attributed to birth
injuries such as stretch marks.
Also called “salmon patches”, they occur in about one third of all newborn
infants. They are flat, pink areas with irregular borders, and may become
darker with crying or room temperature changes. They fade with pressure,
but the reddish appearance returns when the pressure is removed. Stork
bites clear up spontaneously over a period of months and are usually gone
completely by 18 months with the exception of those at the nape of the neck.
Those may persist for years, but are generally covered by hair.
23. Some of the experts believe bonding must happen immediately after birth, but most
believe it is truly an individual experience. It should be considered a process rather
than a specific moment, involving cuddling, holding, talking to, etc.
When experts talk about bonding, they're
referring to the intense attachment the parent
develops with the baby, in particular the
mother, due to the biological connection.
Some research indicates that
Infants who have a deep bonding
with their mothers tend to become
very independent at a young age
and display a higher sense of
confidence, positive attitude, and
self-esteem. They appear self-
reliant and enjoy good
relationships with peers, even
when under stress or unstable
home conditions. These children
seem to be more successful in
school, especially in mathematics.
They have good school attendance
and high achievement scores in
comparison to children that did not
bond as deeply with the mother.
24. Father-Newborn Bonding
Most of the bonding research has focused on mother-infant bonding, but in
recent years father-infant bonding has received increased attention. A
special term is used to describe the father-infant relationship at birth--
"engrossment." Engrossment involves the holding and comforting of the
baby and the display of a greater level of sensitivity in the father.
Studies on father bonding show that fathers who
are given the opportunity and are encouraged to
take an active part in caring for their newborns can
become just as nurturing as mothers. A father's
nurturing responses may be less automatic and
slower to unfold than a mother's, but fathers are
capable of a strong bonding attachment to their
infants during the newborn period. Fathers have
their own unique way of relating to babies, and
babies seem to thrive on this difference.
There is also some scientific evidence to support bonding. Cortisol is a hormone
that is regulated by the pituitary-adrenal system. It influences stress reactions, the
immune system, sugar levels in the blood, motor skills, and memory. During the
average day a typical child’s cortisol level peaks in mid- morning and decreases in
the evening. In children who have no parental attachment, the cortisol levels
continue to increase all morning and only decrease slightly by evening.
25. If there is no bonding with a child, the result seems to have a profound and
long-lasting negative effect, often referred to as Reactive Attachment
Disorder. The essential feature of RAD (Reactive Attachment Disorder) is the
"markedly disturbed and developmentally inappropriate social relationships that begin
before age 5 years and are associated with grossly pathological care". By definition,
the grossly pathological care may take the form of persistent disregard of the child’s
basic emotional needs for comfort, stimulation, and affection; the persistent disregard
of the child’s basic physical needs; or repeated changes of primary caretaker that
prevent formation of stable attachments.
Children can exhibit poor peer relations, rage, poor eye contact, limited to no
remorse for destructive or assaultive behaviors, chronic lying, agitating, and
stealing; and preoccupation with morbid topics, destruction or cruelty to animals.
Long term hospitalization
of newborns may prevent
bonding, as well as
neglect or abandonment.
“Holding therapy” during episodes of rage is
one form of treatment being used for RAD.
26. The postpartum period begins after the
delivery of the baby and ends when the
mother's body has returned as closely as
possible to its pre-pregnant state…a period of
six weeks to two years. It involves the
mother’s adjustment to physical, emotional,
and hormonal changes, as well as learning
how to care for a newborn and function in this
new family unit. She will need to rebuild her
strength, getting plenty of rest, good nutrition,
exercise, and help during the first few weeks.
Postpartum depression (PPD) is quite common after
a baby's birth. It can range from mild "baby blues"
which affect between 50 and 80 percent of all
mothers, to psychosis. In general, over 10 percent of
mothers experience some level of postpartum
adjustment problems. When these problems begin to
interfere with a mother's ability to take care of her
baby and her daily tasks, it is time to seek
professional help. Depression is a very real mental
condition, not imagined or voluntary.
27. The mammary gland of the breast, upon
receiving a hormonal signal after the
birth of the baby, begins making
secretions. This process is called
lactation.
The very first secretion from the breast is
called COLOSTRUM. It is sticky, and a milky-
yellow color. It is nature’s perfect baby food:
1. Provides baby with perfect nutrition
2. It is easily digestible
3. Contains immunities from the mother
After several days, the colostrum is replaced
with milk. Although breastfeeding contributes
to bonding the mother and child, it may be limit
how much the father is able to participate in
his baby’s care.
